Court order~2.pdf

Case: 1:88-cv-05599 Document #: 531 Filed: 09/28/16 Page 1 of 60 PageID #:997

IN THE UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF ILLINOIS

EASTERN DIVISION

B.H., et al., )

Plaintiffs, )

v. ) No. 88 C 5599

) Hon. Jorge L. Alonso

GEORGE H. SHELDON, Director, ) Judge Presiding

Illinois Department of Children and )

Family Services, )

Defendant. )

AMENDED AND REVISED DCFS B.H. IMPLEMENTATION PLAN

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TABLE OF CONTENTS

Page

Introduction

I. Implementation Plan Leadership

II. Application of Implementation Science to the Implementation Plan

III. Overarching Outcome Measures

A. Safety

B. Permanency and Stability

C. Wellbeing

IV. Implementation of Specific Recommendations of the Expert Panel

A. Recommendation #1: Institute a children’s system of care demonstration program that permits POS agencies and DCFS sub-regions to waive selected policy and funding restrictions on a trial basis in order to reduce the use of residential treatment and help children and youth succeed in living in the least restrictive, most family-like setting

1. Therapeutic Foster Care Pilots

2. Care Management Entity Pilot

3. Dually-Involved Youth Pilots

B. Panel Recommendation #2: Engage Department offices in a staged ‘immersion’ process of retraining and coaching front-line staff in a cohesive model of practice that provides children and their families with access to a comprehensive array of services, including intensive home-based services, designed to enable children to live with their families

1. Immersion Sites Overview

2. Description of Family-Centered, Trauma-Informed, Strength-Based Practice Model ..29

3. Description of Model of Supervisory Practice (MoSP)

4. Initiation of MoSP Training Model

5. Core Practice Model Expert

6. Statewide Summit

7. Quality Service Reviews

8. Development of Regional Capacity to Expand Service Array

9. Use and Oversight of Flexible Funds

10. Evaluation

C. Panel Recommendation #3: “Fund a set of permanency planning initiatives to improve permanency outcomes for adolescents who enter state custody at age 12 or older either by transitioning youth to permanent homes or preparing them for reconnecting to their birth families reaching adulthood.”

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1. State-funded guardianship assistance should be extended to all children aged 12 and older regardless of IV-E eligibility

2. The definition of kin should be revised to include the current foster parent of a child who has established a significant and family-like relationship with the child, whether related or unrelated by birth or marriage

3. Both changes will result in a savings since the administrative savings are well above the state costs for guardianship assistance payments and revision to the definition of kin will qualify more assistance payments for IV-E reimbursement

4. Implement specific “family finder” strategies as part of permanency planning for adolescents who do not have an obvious reunification plan

D. Panel Recommendation #4: “Retain an organizational consultant to aid the

Department in “rebooting” a number of stalled initiatives that are intended to address the needs of children and youth with psychological, behavioral or emotional challenges.”

1. Reorganization, Strategic Planning and Cultural Change

2. Full Implementation of Designed Initiatives

3. Training and Coaching Program

E. Panel Recommendation #5: Restore funding for the Illinois Survey of Child and

Adolescent Wellbeing that uses standardized instruments and assessment scales modeled after the national Survey of Child and Adolescent Wellbeing to monitor and evaluate changes in the safety, permanence, and wellbeing of children for a representative sample of DCFS-involved children and their caregivers

1. Illinois Survey of Child and Adolescent Wellbeing (ISCAW)

F. Panel Recommendation #6: The implementation plan will provide for the

Department to contract with an external partner to perform an effective residential and group-home monitoring program. T he Department shall use an external partner for that function until such time as the Department has sufficient staff with the necessary experience and clinical expertise to perform the function internally and further has developed an in-house program that can monitor residential and group-home placements effectively

1. Theory of Change

V. Communication Plan

VI. Project for Target Group of Children and Youth

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DCFS B.H. IMPLEMENTATION PLAN

Introduction

In April 2015, this Court appointed a panel of experts pursuant to Federal Rule of

Evidence 706 to evaluate the services and placements provided to plaintiff class members with psychological, behavioral or emotional challenges. In July 2015, the Expert Panel submitted a report to the Court outlining specific findings and making six recommendations for systemic change at DCFS. Under the leadership of then-newly appointed Director George H. Sheldon, DCFS did not dispute the factual findings and committed to address the challenges described by the Expert Panel. DCFS is committed to take action to correct systemic deficiencies and to strive for the safety, permanence, and wellbeing of children and youth in care.

In October 2015, the Court adopted the Expert Panel’s findings, subject to certain revisions proposed by the parties, and reappointed an Expert Panel. The October 2015 Order contemplates collaboration of the parties and the Expert Panel to develop an implementation plan for DCFS to follow as it addresses systemic reform.

Although Director Sheldon was initiating multiple steps to address the challenges and concerns he observed at DCFS, the July 2015 Expert Panel recommendations sparked further urgency and a broader approach to DCFS reform. DCFS now has a number of critical and innovative initiatives under way that are intended to address many of the underlying challenges referenced in the report, but there is still a long way to go to implement those initiatives fully in order to evaluate and sustain their success. These initiatives are being implemented in accordance with the requirements of implementation science. Work has already begun to spread seeds of cultural change, a sense of urgency and clear planning and ownership at multiple levels of DCFS. Success in those efforts will be a critical factor as the broader work begins. In addition, DCFS continues its work to determine an overarching strategy that will connect

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The Parties jointly submitted the DCFS B.H. Implementation Plan to the Court on

February 23, 2016. Since the submission of the Implementation Plan, at the Court’s instruction, the parties have submitted additional and supplemental information regarding the initiatives in the Implementation Plan. These are incorporated into this Amended and Revised DCFS B.H.

Implementation Plan.

This Amended and Revised Implementation Plan sets forth the specific steps DCFS will take to begin addressing the six recommendations and the specific needs of children and youth in care with psychological, behavioral or emotional challenges. Additionally, in accordance with implementation science, each initiative contains a logic model which incorporates the Expert

Panel’s comments.

The Plan represents a core component of the overarching DCFS strategic plan a draft of which has been published for public comment. The direction of DCFS is to embed child and family centered practice into a system where all leaders, administrators and staff have a sense of urgency toward reaching the best possible outcomes for children and families in Illinois.

I. Implementation Plan Leadership

With the input of the Expert Panel, DCFS has appointed Pete Digre as Deputy Director for Placement and Community Services with complete authority and responsibility for operationalizing the Implementation Plan. Mr. Digre reports directly to Director Sheldon and has authority to direct DCFS staff and private providers, and to assign staff to specific aspects of the Implementation Plan. This definition of authority and unequivocal leadership will assist in the breakdown of silos between divisions and drive implementation in a cohesive and integrated manner.

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Mr. Digre has extensive experience in developing and implementing child welfare programs in Illinois, Philadelphia, Florida and Los Angeles, including specialized intensive and therapeutic foster care programs. Exhibit A, Resume of Pete Digre.

II. Application of Implementation Science to the Implementation Plan

In developing the overall Implementation Plan as submitted on February 23, 2016, DCFS was guided by principles of implementation science as put forth by the National Implementation

Research Network (NIRN). These principles suggest that successful implementation requires thoughtful phasing (“Stages of Implementation”), teaming, and continuous data monitoring

(“Plan-Do-Study-Act” cycles), as well as careful examination of organizational drivers that may help or hinder innovation and provide the organizational capacity to address technical and adaptive challenges. Exhibit B, Stages of Implementation Analysis: Where Are We?;

Implementation Science: Changing Hearts, Minds, Behavior and Systems to Improve

Educational Outcomes.

A logic model for each initiative and project has been developed and reviewed by the

Expert Panel. Logic models are graphical depictions of the logical relationships between the resources, activities, outputs, and outcomes of a program. Logic models are tools used by evaluators of programs to evaluate the effectiveness of the programs. One of the important uses of logic models is for program planning, helping program managers to plan with the end or desired results in mind. See Designing Evaluations, Applied Research and Methods, U.S.

Government Accountability Office, 2012 Revision.

In order to operationalize the Implementation Plan in a structured way, evaluation templates were prepared by Mark Testa to assist the Strategic Planning and Innovation Division and DCFS project managers and staff. The templates are adapted from materials that Dr. Testa helped develop. Exhibit C, A Framework To Design, Test, Spread, and Sustain Effective

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Practice in Child Welfare, Children’s Bureau, Administration for Children and Families, U.S.

Department of Health and Human Services (2014).

Logic models and status reports based on the evaluation templates are provided for each pilot and initiative described in the Implementation Plan.

The National Implementation Science Research Network (NIRN) will assist DCFS in the application of implementation science to its implementation efforts for the B.H. Implementation

Plan. DCFS is in the process of completing the contract with Alison Metz, NIRN Senior

Scientist. After consultation with the Expert Panel, the current plan will require Dr. Metz to review and comment on DCFS’s adherence to best practices in implementation science and assist with an assessment of DCFS’s implementation capacity and strategy. DCFS will provide NIRN with logic models and implementation plans for each separate pilot, project and initiative. With respect to each initiative, Dr. Metz will provide guidance and direction on: what is going well, the identification of potential barriers to implementation of reform, and possible ways to overcome and address such barriers. In particular, Dr. Metz will offer guidance around the architecture and teaming structure of the pilots, projects and initiatives. In addition, DCFS will, as needed, seek assistance from Dr. Metz as implementation moves forward. Under the consulting arrangement, the Plaintiffs and the Expert Panel members will be permitted to freely communicate with Dr. Metz about their work on an ex parte basis.

III. Overarching Outcome Measures

As a result of collaboration with the Expert Panel and DCFS consultant Dr. Mark

Courtney, DCFS identified specific outcome metrics to assess the safety, permanency and wellbeing of class members. These metrics are intended to monitor changes in both the quality of, and capacity to provide, services and supports for children and families in the Illinois child welfare system. Notably, every state child welfare system is measured by the United States

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Department of Health and Human Services, Administration for Children and Families. For purposes of this Implementation Plan, DCFS will use the same safety and permanency outcome measures that are currently utilized by the federal government in the Child and Family Service

Review (CFSR) process. The data for the safety, permanency, and stability metrics will be drawn from existing DCFS data sources and based on the Adoption and Foster Care Analysis and Reporting System (AFCARS) and National Child Abuse and Neglect Data System

(NCANDS). Though not as a measure of compliance with the Expert Panel’s report, DCFS will routinely track and monitor other data indicators as part of this Implementation Plan that are discussed under Recommendation #4. See discussion infra at pp. 42-52.

The CFSR, however, does not track wellbeing outcomes with specificity. Therefore, DCFS will use wellbeing measures developed by the Illinois Child Welfare Advisory Committee

(CWAC) Sub-Committee on Wellbeing. CWAC was established pursuant to executive order and provides counsel regarding emerging policy issues and best practices in child welfare. The

CWAC Sub-Committee on Wellbeing is comprised of experienced, credentialed DCFS and private agency stakeholders and child welfare experts at Northwestern University. Exhibit D, CWAC Sub-Committee and Sub-Committee membership list.

A. Safety

The selected safety measure from the CFSR is maltreatment in foster care:

“Of all children in foster care during a 12-month period, what is the rate of victimization per day of foster care?”

See Exhibit E, Final Notice of Statewide Data Indicators and National Standards for Child and

Family Services Reviews.

B. Permanency and Stability

The selected permanency and stability measures are:

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1. Permanency in 12 months for children entering foster care: “Of all children who enter foster care in a 12-month period, what percent are discharged to permanency within 12 months of entering foster care?”

2. Permanency in 12 months for children in foster care 12 to 23 months: “Of all children in foster care on the first day of a 12-month period who had been in foster care (in that episode) between 12 and 23 months, what percent discharged from foster care to permanency within 12 months of the first day of the period?”

3. Permanency in 12 months for children in foster care 24 months or more: “Of all children in foster care on the first day of a 12-month period, who had been in foster care (in that episode) for 24 months or more, what percent discharged to permanency within 12 months of the first day?”

4. Re-entry to foster care in 12 months: “Of all children who enter foster care in a 12-month period who discharged within 12 months to reunification, living with a relative, or guardianship, what percent re-enter foster care within 12 months of their discharge?”

5. Placement stability: “Of all children who enter foster care in a 12-month period, what is the rate of placement moves per day of foster care?”

C. Wellbeing

Because the CFSR process does not provide for specific data measures for child wellbeing, DCFS will measure wellbeing based on a matrix that was developed by the CWAC

Sub-Committee. The matrix is premised on the four functional domains (cognitive functioning;

physical health; emotional/behavioral functioning; and social functioning). The CWAC Sub-

Committee has submitted a final matrix which has been forwarded to the Expert Panel for review. Exhibit F, Matrix.

Many of the wellbeing indicators in the matrix will be gathered from existing DCFS data sources. For the indicators that are not currently available because DCFS does not have accessible data sources, the DCFS Office of Information Technology will develop and incorporate data sources to measure the outcomes associated with the wellbeing matrix.

One of the existing DCFS data sources from which the wellbeing indicators will be gathered is the Child and Adolescent Needs and Strength Assessment tool (CANS). CANS

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Outcomes system. To assess the validity of CANS findings, DCFS will develop and implement in the selected immersion sites an independent quality service and progress review consisting of the periodic collection of data from external sources, such as children and youth, foster parents and teachers to compare to CANS findings. The Psychiatric Hospital database has been finalized.

It permits DCFS to collect data regarding youth who have been and are currently psychiatrically hospitalized, critical information to confirm the CANS.

In addition, DCFS is developing a database for data from the Illinois State Board of

Education (ISBE) that will include the Student Information System that monitors a student’s progress over time and tracks school enrollment, attendance and progress. The DCFS technology upgrade required to allow the acceptance of this data into the Statewide Automated Child

Welfare Information System (SACWIS) is due to be completed in 6-12 months.

IV. Implementation of Specific Recommendations of the Expert Panel

A. Recommendation #1: Institute a children’s system of care demonstration program that permits POS agencies and DCFS sub-regions to waive selected policy and funding restrictions on a trial basis in order to reduce the use of residential treatment and help children and youth succeed in living in the least restrictive, most family-like setting.

DCFS will begin implementing Recommendation #1 through four pilot projects targeted at populations of children with emotional and behavioral needs and/or youth involved in both the juvenile justice and child welfare systems (“dually involved”). The goal of the pilot projects is to reduce lengths of stay in residential facilities and increase placements in community and home-based settings. DCFS is committed to the pilot project process, and the four pilots described below have been launched. Each of these pilots includes a rigorous evaluation component. If the evaluation demonstrates that the pilots are meeting stated goals, it is anticipated that they will be rolled out more broadly across the state. If they are not effective, Case: 1:88-cv-05599 Document #: 531 Filed: 09/28/16 Page 11 of 60 PageID #:1007 they will be modified or discontinued, and alternative approaches will be pursued as appropriate and necessary.

1. Therapeutic Foster Care Pilots

a. Pilot Overview

DCFS will pilot the use of therapeutic foster care through evidence-based or evidence-informed models in three sites over the next five years. Therapeutic Foster Care (TFC) is a community-based service for children and youth whose emotional or behavioral health needs can be met through services delivered primarily by foster parents, as an alternative to high-end, restrictive placements such as residential treatment, incarceration, and/or psychiatric hospitalization. See http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5310a1.htm. The goal of the Therapeutic Foster Care Pilot is to develop and test the effectiveness of various models of Therapeutic Foster Care for children and youth with emotional disturbance who are in

DCFS custody.

i. Theory of Change

The Theory of Change employed by DCFS in the therapeutic foster care pilot is that children and youth thrive when cared for within a home and family environment and that placement in a residential setting is a point-in-time intervention to respond to the clinical needs of children and youth. Therapeutic foster care will be implemented in areas of high need in Illinois to reduce the number of youth in residential treatment facilities and increase both placement stability and clinical functioning. Exhibit G, DCFS Logic Model and Status

Report, Therapeutic Foster Care.

DCFS set a two-year goal for each program for the recruitment of therapeutic foster parents and placements. This goal will include the placement of a minimum of 40 children and youth in TFC licensed homes at the end of the first contractual year; and placement of a http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5310a1.htm

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b. Development of Therapeutic Foster Care Evidenced-Based Models

DCFS began the pilot project in September 2015 with the issuance of request for proposals for TFC programs. The programs were targeted for Cook, Kane and Winnebago counties based on an analysis of the current DCFS population by Chapin Hall at the

University of Chicago (Chapin Hall), because those areas were found to have the highest need for alternative placements for youth with serious emotional or behavioral health needs.

DCFS identified three groups of children and youth for the TFC pilots which include:

children who without more intensive services were likely to later enter residential care (i.e., deflection group, later entry), children who were entering residential care directly upon placement with DCFS (i.e., deflection group, direct entry), and children who were ready for step down from residential care (i.e., step-down group). DCFS specifically identified these groups to correspond with the requirements of the Children and Family Services Act.

DCFS received twenty-six responses to the RFP, which were reviewed and analyzed.

A pre-bidders conference was held to answer questions from bidders. DCFS then scored the proposals based on a matrix developed in collaboration with Chapin Hall. In early 2016, The Act provides: “Multi-dimensional treatment foster care. Subject to appropriations, beginning June 1, 2016, the Department shall implement a 5-year pilot program of multi-dimensional treatment foster care, or a substantially similar evidence-based program of professional foster care, for (i) children entering care with severe trauma histories, with the goal of returning the child home or maintaining the child in foster care instead of placing the child in congregate care or a more restrictive setting or placement, (ii) children who require placement in foster care when they are ready for discharge from a residential treatment facility, and (iii) children who are identified for residential or group home care and who, based on a determination made by the Department, could be placed in a foster home if higher level interventions are provided.” 20 ILCS 505/5.40.

Case: 1:88-cv-05599 Document #: 531 Filed: 09/28/16 Page 13 of 60 PageID #:1009 bidders with top scores gave oral presentations to DCFS staff. DCFS selected three private agencies based on the combination of their written proposals, proposal scores, and oral presentations: Lutheran Social Services of Illinois (LSSI) for pilots in Cook County, Aurora and Rockford; Children’s Home and Aid of Illinois (CHAID) and Jewish Child and Family

Services (JCFS) for pilots in Cook County.

During the exploration phase, DCFS Chapin Hall, LSSI, CHAID and JCFS reassessed the potential match between the target population, the proposed evidenced-based model, program needs, and community resources. The exploration phase included meetings and discussions with the developers of the various evidenced-based models and consultation with

Marci White. As a result of the Expert Panel’s guidance, each private agency modified their original proposals to implement improvements.

LSSI will implement the Treatment Foster Care Oregon Children (TFCO) model in combination with a number of programs, for children 6 – 11 years of age in all three target regions. LSSI expanded their proposal to also include youth ages 12 – 14 in consultation with the TFCO developers for all three sites. LSSI will be serving 30 youth, 10 in each site. LSSI will implement a professional foster parent model where one parent will not work outside of the home. Exhibit I, LSSI Therapeutic Foster Care Implementation Plan.

CHAID and JCFS both proposed a Therapeutic Foster Care model that meets DCFS’

Therapeutic Foster Care definition through implementation of the Keeping Foster and Kin

Parents Supported and Trained (KEEP) model. After discussions with the KEEP model developer, however, it was decided that the KEEP model was not a good fit for this population.

With assistance from both Chapin Hall and Marci White, CHAID and JCFS identified other evidence-based interventions that would meet the DCFS Therapeutic Foster Care model definition. CHAID will be serving youth ages 12 to 18 in the step down population. CHAID

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Crisis Intervention for Families (TCI), Trauma-Focused Cognitive Behavioral Therapy (TF-

CBT), Attachment, Self-Regulation and Competency (ARC), Quality Parenting Initiative

(QPI), Excellence Academy and Adult Connections. Exhibit J, CHAID Therapeutic Foster

Care: Implementation Plan and Theory of Change. Through the use of the above mentioned programs, CHAID will serve youth in Cook County and anticipates serving ten youth in the first year.

JCFS will serve youth ages 12 to 18 in the deflection step down and trauma populations. JCFS be using the Together Facing the Challenge model, which is an evidence-based practice model that provides comprehensive training for both agency staff and treatment foster care parents. JCFS anticipates serving 10 youth in the first year. Exhibit K, Jewish

Child and Family Services Therapeutic Foster Care Pilot Implementation Plan.

Each private agency and DCFS staff has had in person meetings with the developers of the evidence-based models. LSSI and DCFS met with the developers of TFCO on June 20, 2016, CHAID met with the developers of TCI on August 15, 2016 and JCFS met with the developers of Together Facing the Challenge on August 29, 2016. The meetings allowed the private agencies and DCFS to get a clear understanding of the specific model, the required training, fidelity monitoring and sustainability issues. DCFS has established rates and has finalized grant contracts for each agency. The grant contracts will allow the agencies to hire, recruit and train staff for the pilots and each agency has begun the recruitment and hiring process. After each agency has appropriate staff in place, DCFS will develop service contracts to be put in place by the time the first children or youth are placed in the pilot.

c. Oversight of TFC Implementation Steps

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DCFS and the private agencies developed a committee structure to provide necessary guidance for future decisions. Exhibit L, Therapeutic Foster Care Committee Structure. The

TFC Steering Committee includes representation from each agency and high level DCFS staff and meets on a monthly basis. The Steering Committee serves in an advisory capacity to provide input and guidance throughout both the implementation and evaluation phases.

Steering Committee members will assist with identifying solutions to system barriers that may affect implementation of evidence based practices.

The TFC Evaluation/Eligibility Sub-Committee is responsible for developing eligibility criteria for youth entering the pilot and criteria for step down from therapeutic foster care treatment. The sub-committee will be responsible for compiling and analyzing data relevant to decision making. The sub-committee will also be responsible for developing the evaluation plan. The committee is co-chaired by Dr. Cynthia Tate, DCFS Senior Deputy Director, Program Practice and Dr. Richard Epstein, Chapin Hall.

Implementation sub-committees will be developed. An implementation team will be established for each evidence-based model that is being used in the TFC pilot (Therapeutic

Foster Care Implementation Sub Committee, Together Facing the Challenge Implementation

Sub Committee and Therapeutic Crisis Intervention for Families Sub Committee.) Each implementation sub-committee will provide direction for the operational planning and initial and ongoing implementation of the evidence-based model. The sub-committees will be responsible for identifying barriers to implementation and decision making regarding the principles of plan- do-study-act to support information based decision making and continuous learning.

d. Evaluation by Chapin Hall

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The evaluation of the TFC pilot programs will be conducted by Chapin Hall. Chapin

Hall completed a comparison of the providers’ programs and the Foster Family Treatment

Association Standards. Exhibit M, Program Comparison. While the evaluation component is not complete, wellbeing measures will be included. DCFS identified proximal and distal outcomes for the TFC pilots. The proximal outcomes include decreased percentages of entries and re-entries into residential care, increased placement stability and increased clinical functioning. The distal outcomes include increased safety, improved permanency, and improved wellbeing outcomes.

e. DCFS Leadership of the TFC Pilot

The implementation of this project will be led by Twana Cosey, M.S.W., Statewide

Recruitment Administrator, working in close collaboration with Peter Digre. Mr. Digre leads a team that includes managers from the DCFS Clinical, Licensing, Operations and Training

Divisions.

2. Care Management Entity Pilot

The Illinois Care Management Entity (CME) pilot arose out of changes that began in

2012 in federal and state law which signaled a shift toward managed care and a potential impact on Medicaid behavioral health services to children and youth in DCFS custody. At the same time, DCFS noticed a trend in the increased length of time that children and youth were remaining in care and also remaining in institutional settings. DCFS and other state agencies worked with Shelia Pires, a national System of Care expert, in researching viable options to address these issues for Illinois. This work led to the identification of Choices, a CME with over

15 years of experience providing care coordination services. The CME pilot began in February

2014 and currently serves DCFS youth ages three to 21 who are placed in congregate care settings, in psychiatric hospitals, in specialized foster homes and in traditional foster homes, but

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The Theory of Change for this pilot is that implementation of system of care principles, such as the increased use of cost-effective home and community based services and care coordination oversight, will result in better clinical and permanency outcomes for children and youth with mental health conditions. The implementation of the CME pilot is set forth in the

Logic Model. Exhibit N, CME Logic Model. An status report is also attached. Exhibit O, CME

Status Report.

a. Pilot Overview

As the CME, Illinois Choices provides care coordination services based upon Systems of

Care principles to children with severe and complex behavioral health concerns. The pilot serves children in DCFS custody who have a head of household address or legal county of origin in

Champaign, Ford, Iroquois or Vermilion counties and who are either: 1) in psychiatric hospitals, residential /group home facilities, or specialized foster care; or 2) have been screened due to a psychiatric crisis; or 3) in traditional foster care and are experiencing placement stability issues.

The four counties for the pilot were selected based upon high intake rates and long lengths of stay for children in those areas.

b. Child and Family Teaming Model

The CME’s care coordination services are provided through an intensive Child and

Family Teaming (CFT) model that is implemented according to High Fidelity Wraparound standards. See National Wraparound Standards, attached as Exhibit P. When a child is enrolled in the CME pilot, a care coordinator is assigned and begins an engagement process to establish a

CFT that includes the child, the permanency worker, any available family members, and other natural supports, such as teachers, friends, mentors and neighbors. The care coordinator

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Each member of the CFT has specific responsibilities. The care coordinator is responsible for scheduling and facilitating the CFT, for ensuring that all necessary services are properly authorized and that access to services is streamlined. The assigned permanency worker is responsible for ensuring that the permanency goal drives all of the CFT planning and that

DCFS rules, procedures and policies and all court orders are being met. The permanency worker and care coordinator work as a team.

c. CME Provider Network

The CME provides care coordination, administration and oversight of the Provider

Network, which is comprised of community-based providers who are willing to offer services to children and families enrolled in the program. Importantly, the CME is not a direct provider of therapeutic services. This permits “conflict-free” care coordination.

The CME pays providers directly, thus maintaining control of the network and allowing for flexibility to add new providers and services as needed for an individual child. The Provider

Network began with only providers who had existing contracts with DCFS for both placement and therapeutic services. The CME has expanded the network to include other non-traditional providers (e.g., equine therapist, mentors, family peer supports, etc.) not previously under contract with DCFS. The CME Provider Network continues to expand to cover additional service types and providers.

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Home and community-based behavioral health services currently available within the

CME Provider Network include, but are not limited to: therapy – individual, family, group, and specialty (e.g., equine); community support – individual and group; evaluation and testing services; and behavior management services. Expanded child welfare support services include, but are not limited to: team meeting participation; court hearing attendance; mentoring – educational, social, recreational, life coach, independent living skills, family and parent; tutoring;

supervised visitation; shared parenting and coaching; family support services including camp;

childcare reimbursement; transportation; incentives; utilities; supplies; activities; medical;

clothing; and restitution and damage repaid.

d. Flexible Funding

The CME manages specific funds for “flexible spending” for each child enrolled in the program. These funds are pooled across all children providing the opportunity to secure additional creative and flexible services and supports for children with higher needs. The CME accesses Medicaid reimbursed services whenever possible to ensure that flexible funds are only utilized for services and supports not already available in the community.

Mental health services currently available through flexible funding include home-based services (utilizing evidence-informed practices), enhanced mobile crisis response, crisis stabilizers, crisis respite, therapeutic mentoring services, peer support and non-crisis respite. The goal is for such services to be integrated by the Illinois Department of Healthcare and Family

Services (which is the Illinois State Medicaid agency) into the federally approved Medicaid service array.

e. Enhanced Mobile Crisis Response

In April 2016, an enhanced Mobile Crisis Response program was launched as part of the

CME pilot. The Mobile Crisis Response program is for youth in care and also youth in the

Case: 1:88-cv-05599 Document #: 531 Filed: 09/28/16 Page 20 of 60 PageID #:1016 community who are experiencing behavioral health crises that may require hospitalization or may lead to them being removed from their current placement. This enhanced Mobile Crisis

Response replaces the previous pre-hospitalization screening service that was offered prior to the

CME pilot being implemented. The enhancements to the crisis program include a team-based response with a crisis responder and care coordinator (for children enrolled in the CME pilot), expanded services available immediately to the youth/caregiver and an expanded definition of what constitutes a “crisis.” Previously, a youth had to be experiencing a “psychiatric” crisis, however, under the new Mobile Crisis Response, a crisis can include behavioral health issues that may result in the child losing their current placement or being removed from the home.

f. Goals and Outcomes for CME Pilot

The CME pilot is intended to keep children stabilized in the least restrictive placement possible, to move children to sustained permanency as soon as they are ready, and to ensure children’s and families’ interests and participation directly influence the planning and delivery of services. The goal is to develop a network of community providers who offer a long-term community-based support system after the children achieve permanency.

g. DCFS Leadership of CME Pilot

The CME pilot is administered by DCFS’s Care Coordination Office, overseen by

Kristine Herman, Associate Deputy Director of Medicaid Behavioral Health and Care

Coordination within the Strategic Planning and Innovation Division. The Care Coordination

Office authorizes all referrals to the CME, oversees the implementation of the pilot program and ensures that administrative issues are addressed at the field level by interacting directly with both private agency and DCFS permanency workers and other staff.

The Care Coordination Office is also responsible for ongoing oversight of the implementation of the pilot through CME compliance reviews and quarterly and annual

Case: 1:88-cv-05599 Document #: 531 Filed: 09/28/16 Page 21 of 60 PageID #:1017 outcomes reports by the CME. Additional baseline data, outcomes and performance benchmarks will be reported by r the University of Illinois at Urbana-Champaign tasked with evaluating the

CME project. These reports will be used to assess the impact of the pilot as it continues to be implemented and before the final evaluation is completed.

h. CME Pilot Time Frames and Capacity

The CME pilot started in February 2014 and is currently scheduled to last for three years.

The pilot is designed to serve approximately 200 children annually and 600 during the course of the three year pilot. The daily census as of approximately September 9, 2016, is 150, and a total of 310 children have been served in the pilot since February 2014.

Lessons learned from the two years of the CME pilot have been applied to the development of the immersion sites as set forth in Recommendation #2. See discussion infra at

pp. 25-38. Through the CME pilot, DCFS has begun to localize processes within the regional structure of the CME allowing more local control and further empowering CFTs to make decisions regarding the best services and placement types for children. For example, the Clinical

Intervention for Placement Preservation (CIPP) has been eliminated for children enrolled in the

CME and the centralized process for placing children in substitute care (Central Matching) is being replaced. DCFS is committed to continuing the process of reinforcing local control of various policies and processes, since this local integration has been shown to be effective in the

CME pilot.

In addition, DCFS recognizes that any system change processes, such as those undertaken in the CME pilot, must have strong administrative oversight and support. Because changing the culture of a system requires consistent messaging, over time, a single administrator of the program with direct access to executive leadership was established. This administrative structure has allowed policy, procedural and other system barriers to be addressed in the pilot helping to

Case: 1:88-cv-05599 Document #: 531 Filed: 09/28/16 Page 22 of 60 PageID #:1018 propel culture change. This also ensures that both DCFS and private agency staff are held accountable for honoring the CFT model integral to the pilot, which represents a completely new way of doing business.

i. CME Evaluation

The Psychology Department at the University of Illinois at Urbana-Champaign will be performing a full evaluation of the CME pilot project. DCFS and the University of Illinois are completing a data sharing agreement. The current plan for the evaluation includes identification of a comparison group by the end of December 2016 and the completion of an interim evaluation by March 2017. A full evaluation of the efficacy of the pilot will be completed after the full three years period of the pilot has been completed in 2017.

3. Dually-Involved Youth Pilots

Dually-involved youth are involved with the child welfare and juvenile justice systems simultaneously. These youth face complicated challenges and generally require a more intense array of services and supports than other youth known to each system individually. There is little cross-systems collaboration between the child welfare and the juvenile justice systems.

To address the unique challenges of this population, DCFS initiated two separate pilots to determine the most effective strategies for attaining better outcomes for these youth. The

Regenerations pilot provides intensive placement finding with additional supportive services to move children out of detention as soon as possible. The Pay for Success pilot is funded by private dollars and offers intensive care coordination through a fidelity wraparound process to dually involved youth. Both pilots are running simultaneously to determine which model produces the best outcomes for dually-involved youth. The pilots are described in more detail below.

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a. Regenerations Pilot Project for Dually-Involved Youth at Cook

County Juvenile Detention Center

DCFS engaged Dr. Alan Morris and Deann Muehlbauer, from the University of Illinois at Chicago Behavioral Health Program to review and assess the DCFS system, placement resources and the current system for matching and placing youth in residential treatment facilities in response to the Plaintiffs’ Motion to Enforce the Consent Decree. This review identified a high-risk population of youth who remain in the Cook County Juvenile Temporary

Detention Center (JTDC) for long periods of time after their release date and who are often placed directly from JTDC into residential treatment facilities, where they remain for long periods of time. Exhibit Q, JTDC RUR/Regenerations Pilot Presentation. The consultants further determined that this population of youth and families were often difficult to engage and resistant to services, presented complex mental health and behavioral challenges and exhibited high levels of environmental stress. The Regenerations/RUR pilot (Release Upon Request) was initiated to address these long stays of youth at the JTDC by developing additional placement and resources for this population. In order to support the Regenerations process

DCFS has contracted with ChildServ and National Youth Alternatives Program to develop more foster homes for dually involved youth.

The theory of change developed for the Regenerations RUR project is that services provided under a wraparound philosophy result in better outcomes for youth being released from detention, including placements in less restrictive settings than residential treatment facilities. The wraparound services include intensive care coordination, family and youth peer support services, intensive in-home services, respite care, mobile crisis response and stabilization and use of flexible funds. Federal research supports this theory of change.

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The implementation of the Regenerations pilot is set forth in the Logic Model attached as Exhibit R. A status report which adheres to the structure of the Logic Model is attached as

Exhibit S.

ii. Pilot Overview

The Regenerations/RUR (Release Upon Request) pilot began July 6, 2015, and serves youth ages 12 - 18 years old who are 1) in the custody of DCFS, 2) are detained in the Cook

County Juvenile Temporary Detention Center (JTDC), and 3) have been determined by a judge to be ready for release (RUR). Based upon the evaluation of dual ward detention data in previous years, the pilot was developed to serve a total of 65 youth, and 56 youth are currently enrolled. Youth in this pilot receive specialized services including intensive mentoring services and priority placement in home and community settings.

Upon the notification from the courts that a youth is eligible for RUR, DCFS Legal notifies a DCFS Child Protection Supervisor and the Regenerations pilot program manager to open the case. Regenerations pilot staff interview the youth within 24 hours of notification.

Immediately upon assignment to the Regenerations pilot, an assessment is initiated to identify the youth’s strengths and needs, while still detained at JTDC. Family and court-appointed stakeholders also are engaged in this assessment. Shortly after the initial assessment begins, a

CIPP meeting is held at JTDC to establish a Child and Family Team (CFT), which is led by the

Regenerations staff assigned to the case and includes a CIPP Facilitator. The CIPP Facilitator completes the Child and Adolescent Service Intensity Instrument (CASII) to document the youth’s service intensity level. The CFT utilizes the CASII to develop an Individualized Service

Plan that identifies the services required to support the youth’s strengths and needs. The

Individualized Service Plan is completed within 30 days.

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At least quarterly, continued CFTs take place to provide care coordination, assuring the

Individualized Service Plan is implemented according to the youth’s case plan action steps and timeframes for implementing those steps. The plan includes additional services such as comprehensive mental health assessment, mentoring and advocacy services at a minimum 7 ½ to

30 hours a week, program-funded employment, crisis intervention, and flexible funding to meet the needs of individualized youth.

iii. Evaluation

Chapin Hall anticipates finalizing its evaluation for the Regenerations Pilot by late 2017 or early 2018, with periodic interim evaluations. The key outcome measures will focus on the reduction in the days youth are detained in the JTDC beyond their release date, increase in the number of youth released directly to home and community-based settings, increase in the provision of needed community-based behavioral health services, and child welfare support services resulting in a reduction in the days youth reside in a residential placment.

iv. DCFS Leadership

This project is being led by Pete Digre, Deputy Director of Placement and Community

Services. The Project Manager for this pilot is Elizabeth Kling, Associate Deputy Director, Juvenile Justice and Pilot Programs.

b. Illinois Pay for Success Pilot for Dually Involved Youth

In September 2013, the Governor’s Office of Management and Budget announced a request for proposals (RFP) for Social Impact Bonds to spur better outcomes for Illinois youth. The RFP focused on two specific areas: 1) increasing placement stability and reducing re-arrests for youth in DCFS legal custody with histories of justice involvement;

and 2) improving educational achievements and living wage employment opportunities for justice involved youth most likely to reoffend upon return to their communities. Exhibit T, Case: 1:88-cv-05599 Document #: 531 Filed: 09/28/16 Page 26 of 60 PageID #:1022

Press Release on Social Impact Bonds. The Social Impact Bond model is premised on government agencies teaming up with service providers and private sector investors to create and fund innovative social programs. Private sector investors provide start-up funds and then get re-paid when the programs reach specific outcome targets. Social Impact

Bonds are designed to create innovative evidence based solutions to address social issues while at the same time limiting risks to tax payers. In May 2014, the Conscience

Community Network, LLC (CCN) was selected through the RFP process to develop a Pay for Success project for dually involved youth in Illinois. Exhibit U, Illinois Dually-Involved

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